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Published on: August 4, 2018
Surgical antimicrobial prophylaxis in Japanese hospitals: Real status and challenges
Hiroshi Morioka1, Yusuke Koizumi2, Toshitaka Watariguchi3
1Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan.
Insights
Surgical antimicrobial prophylaxis (SAP) adherence in Japanese hospitals is low, with only 33.9% appropriateness overall. Targeted interventions and ongoing surveillance are crucial for improving SAP prescriptions and patient outcomes.
Area of Science:
- Healthcare Research
- Infectious Disease Prevention
- Surgical Safety
Background:
- Limited data exists on surgical antimicrobial prophylaxis (SAP) practices in Japanese hospitals.
- This study addresses the gap by investigating SAP prescription patterns and guideline adherence.
Purpose of the Study:
- To evaluate the current status of surgical antimicrobial prophylaxis (SAP) prescriptions in Japanese hospitals.
- To assess adherence to established Japanese SAP guidelines across various surgical settings.
Main Methods:
- A multicentre, 1-day point prevalent survey was conducted across 27 hospitals in Aichi Prefecture, Japan.
- Appropriateness of SAP was assessed based on antimicrobial selection and duration according to guidelines.
- A total of 728 patients receiving SAP were included in the analysis.
Main Results:
- Overall appropriateness of SAP was 33.9%, with significant variation across surgical fields and hospital types.
- Appropriate antimicrobial selection before/during surgery was 67.5%, but decreased to 43.3% for duration after surgery.
- Cefazolin was the most frequently used antimicrobial, but 101 oral antimicrobials were inappropriately prescribed postoperatively.
Conclusions:
- This study highlights suboptimal adherence to SAP guidelines in Japanese hospitals.
- Intensive interventions and continuous surveillance are necessary to enhance SAP practices and antimicrobial stewardship.
Background:
Information regarding the status of surgical antimicrobial prophylaxis (SAP) in Japanese hospitals is lacking. This study aimed to explore the status of SAP prescriptions for surgeries and adherence to Japanese SAP guidelines.
Methods:
From February to July 2020, a 1-day multicentre point prevalent survey was conducted at 27 hospitals in Aichi Prefecture, Japan. Patients prescribed SAP were included in this study. The appropriateness of the SAP was evaluated based on the guidelines for selection of antimicrobials and their duration. Surgery was defined as appropriate when all the items were appropriate.
Results:
A total of 728 patients (7.1 %; 728/10,199) received antimicrobials for SAP. Among them, 557 patients (76.5 %, 557/728) underwent the surgeries described in the guidelines. The overall appropriateness of all surgeries was 33.9 % (189/557). The appropriate selection of antimicrobial before/during and after surgery and their durations were 67.5 % (376/557), 67.5 % (376/557), and 43.3 % (241/557), respectively. The overall appropriateness ranged from 0 % (0/37, oral and maxillofacial surgery) to 58.7 % (88/150, orthopaedic surgery) and 27.7 % (36/130, community hospitals with 400-599 beds) to 47.2 % (17/36, specific hospitals). Cefazolin was the most prevalent antimicrobial prescribed before/during (55.5 %, 299/539), and after (45.1 %, 249/552) surgery. In total, 101 oral antimicrobials were prescribed postoperatively.
Conclusions:
SAP adherence by specific surgical fields and hospitals was shown in this study. Intensive intervention and repeated surveillance are necessary to improve SAP prescriptions in Japanese hospitals.
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